MEDICARE: FATOUMATA BA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LF0000X	Family Nurse Practitioner	0314991	MD

General Provider Information

NPI Number	:	1881291870
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	FATOUMATA BA

Provider Business Mailing Address
First Line	:	1613 SCOTCH PINE DR
Second Line	:
City	:	BOWIE
State	:	MD
Zip	:	20721-2789
Country	:	US
Telephone Number	:	202-200-5492
Fax Number	:

Provider Business Practice Location Address
First Line	:	9900 WASHINGTON BLVD N STE L
Second Line	:
City	:	LAUREL
State	:	MD
Zip	:	20723-1972
Country	:	US
Telephone Number	:	301-776-4996
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/03/2020
Last Update Date	:	10/03/2020

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Directions to “ FATOUMATA BA ” Practice Location

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